Massachusetts Medical Society Applauds Superior Court Decision on
GIC’s Physician Tiering Program
April 2, 2009
Court allows lawsuit to proceed on defamation, consumer
protection
Contact:
Richard P. Gulla, 781-434-7101
rgulla@mms.org
Waltham, Mass. – April 2 -- The Massachusetts
Medical Society today applauded the
decision of the Suffolk Superior Court in legal action filed by the
Society and five physicians against the Massachusetts Group Insurance
Commission (GIC) and two health plans, allowing a lawsuit to proceed on
two critical issues of physician defamation and consumer protection.
The case centers on the GIC’s Clinical Performance Improvement
initiative, a physician ranking program implemented by the GIC in 2006
that places individual physicians in one of three tiers using various
cost and quality measures. Patients are charged higher co-payment fees
to be treated by physicians assigned to the lower tiers, or must try to
change physicians to avoid higher co-payments.
The Medical Society has said that the program lacks a valid and
accurate methodology to properly evaluate physicians and therefore harms
physicians and misleads patients.
The
Court’s decision responded to requests by the GIC and the
health plans named in the suit to dismiss the lawsuit filed by the
Medical Society and five physicians last year.
Noting that the Medical Society has leading standing to sue on behalf
of its members, the Court, while dismissing several counts in the
complaint as a matter of law, allowed the two most important claims of
defamation and consumer protection, which means the lawsuit can move
forward.
“This is a huge step forward for physicians and
patients,” said Bruce Auerbach, M.D., President of the
Massachusetts Medical Society. “Physicians have been unfairly
evaluated, and patients have been misled by a seriously flawed system
designed simply to control costs. The tiering program forces patients to
pay more for their care, damages the physician-patient relationship and
the hard-earned reputations of physicians. We are thrilled that the
Court has allowed the case to move ahead.”
Last May, the Medical Society and five physicians sued the GIC and
Tufts Health Plans and Unicare, alleging that patients have been
defrauded and harmed and physicians have been defamed by the GIC’s
initiative. The filing asked the court to either stop the tiering
program, or to require that the CPI adhere to specific standards,
including transparency, fair notice, formal feedback and correction
processes, meaningful physician involvement in the development of the
CPI, demonstrate the program’s accuracy, validity and reliability,
and submit their programs to an independent oversight authority.
Dr. Auerbach said the Medical Society took legal action as a last
resort. He said the Society had tried to work with the GIC for four
years in fixing the flaws in the program, but said the GIC refused to
correct the CPI’s most glaring problem, which is its ranking of
individual physicians using inaccurate, unreliable and invalid tools and
data.
Dr. Auerbach said that physicians have been attributed patients they
did not see, and assigned procedures they did not conduct. In addition,
physicians have received reports that are unintelligible, and they have
been given little time to appeal any evaluations.
“Even today,” said Dr. Auerbach, “with the program
entering its fourth year, we are hearing complaints from physicians that
the program is as bad as ever.”
The Massachusetts Medical Society, with more than 21,000 physicians
and student members, is dedicated to educating and advocating for the
patients and physicians of Massachusetts. The Society publishes the New
England Journal of Medicine, a leading global medical journal and web
site, and Journal Watch alerts and newsletters covering 13 specialties.
The Society is also a leader in continuing medical education for health
care professionals throughout Massachusetts, conducting a variety of
medical education programs for physicians and health care professionals.
Founded in 1781, MMS is the oldest continuously operating medical
society in the country. For more information please visit www.massmed.org, www.nejm.org, or www.jwatch.org.
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